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The relationship between upper leg muscle strength and walking capacity in persons with multiple sclerosis
No full textBackground: In persons with multiple sclerosis (PwMS) resistance training improves muscle strength but effects on walking capacity are inconsistent. Objective: The objective was to determine the relation between different types of upper leg muscle strength measurements and walking capacity in PwMS. Methods: An observational cross-sectional study design was applied. Upper leg muscle strength of 52 PwMS (Expanded Disability Status Scale, EDSS range 1.5-6.5) was measured using isometric (knee extensors and flexors) and isokinetic (knee extensors) dynamometry. Walking capacity was assessed using the Timed 25-Foot Walk, Timed Up and Go and Two Minute Walk Test. Subgroups with mild (EDSS 1.5-4.0, n=31) and moderate (EDSS 4.5-6.5, n=21) ambulatory dysfunction were distinguished, and results were hypothesized to differ depending on multiple sclerosis (MS)-related disability status. Correlation and regression analyses were performed on the data of the most affected leg. Results: Greatest (r:0.2-0.7) and significant Pearson correlation coefficients were found in the moderate compared to mild MS subgroup. Within knee extensor measurements, it was found that isokinetic endurance strength related best to walking capacity. When comparing maximal isometric strength measurements, knee flexors (r:0.5-0.7) related better to walking capacity than knee extensors (r:0.1-0.4). Regression analyses confirmed endurance knee extensor strength (similar to 25 %) and isometric knee flexor strength (similar to 40%) as main predictors for walking capacity. Conclusion: Resistance training protocols may consider inclusion of exercises focusing on endurance knee extensor and isometric knee flexor strength when aiming to enhance walking capacity in persons with moderate ambulatory dysfunction.This study was partly supported by IWT Tetra grant #50078, Flanders, Belgium
Spatio-temporal gait parameters change differently according to speed instructions and walking history in MS patients with different ambulatory dysfunction
No full textBackground: Different walking capacity test formats are applied, but their impact on the gait pattern in persons with MS (pwMS) has not yet been investigated according to baseline velocity performance. Objective: To assess, in pwMS with different ambulation dysfunction, the impact of speed instructions and previous walking tests (2 and 6 min walking test; 2MWT and 6MWT) on spatiotemporal gait parameters. Methods: 27 participants, divided in three groups based on usual gait speed (Most Limited Community Walkers; MLCW1.14 m/s, LCW show intermediate values), completed the 2MWT and 6MWT. Before and after each test, they walked on the GAITRite walkway system at both usual and fastest speed. Spatio-temporal gait parameters were measured and analyzed with ANOVA. Results: All gait parameters in the MLCW were significantly different from other groups. In contrast to the MLCW, the LCW and CW subgroups showed greater velocity in the fastest compared to usual speed condition, associated with a significant increase in cadence and step length. After the 6MWT, small changes in cadence at usual speed and step time at fastest speed were observed in the MLCW subgroup only. No impact of the 2MWT on gait parameters was found in any group. Conclusions: The ability to accelerate was dependent on the severity of ambulatory dysfunction. Prolonged walking during the 6MWT has, in contrast to the 2MWT, some impact on gait parameters in the most disabled group only.Peter Feys has received consultancy honoraria from Biogen Idec in 2010-2012 in the domain of mobility, and an unrestricted educational grant via RIMS from NOVARTIS in 2012 for coordinating a project on the content of physical rehabilitation in Europe
Effects of long-term resistance training and simultaneous electro-stimulation on muscle strength and functional mobility in multiple sclerosis
No full text Background: Resistance training studies in multiple sclerosis (MS) often use short intervention periods. Furthermore, training efficiency could be optimized by unilateral training and/or electrical stimulation. Objective: To examine the effect(s) of unilateral long-term (20 weeks) standardized resistance training with and without simultaneous electro-stimulation on leg muscle strength and overall functional mobility. Methods: A randomized controlled trial involving 36 persons with MS. At baseline (PRE) and after 10 (MID) and 20 (POST) weeks of standardized (ACSM) light to moderately intense unilateral leg resistance training (RESO, n = 11) only or resistance training with simultaneous electro-stimulation (RESE, n = 11, 100 Hz, biphasic symmetrical wave, 400 µs), maximal isometric strength of the knee extensors and flexors (45°, 90° knee angle) and dynamic (60–180°/s) knee-extensor strength was measured and compared with a control group (CON, n = 14). Functional mobility was evaluated using the Timed Get Up and Go, Timed 25 Foot Walk, Two-Minute Walk Test, Functional Reach and Rivermead Mobility Index. Results: Maximal isometric knee extensor (90°, MID: +10 ± 3%, POST: +10 ± 4%) in RESO and knee flexor (45°, POST: +7 ± 4%; 90°, POST: +9 ± 5%) in RESE strength increased ( p < 0.05) compared with CON but RESO and RESE did not differ. Also, impaired legs responded positively to resistance training (unilateral leg strength analysis) and functional reaching increased significantly in RESO (+18%) compared with CON. Dynamic muscle strength and the remaining functional mobility tests did not change. Conclusion: Long-term light to moderately intense resistance training improves muscle strength in persons with MS but simultaneous electro-stimulation does not further improve training outcome. </jats:p
Aerobic intensity and pacing pattern during the six-minute walk test in patients with multiple sclerosis
No full textOBJECTIVE: To examine the aerobic intensity level and pacing pattern during the 6-min walk test (6MWT) in persons with multiple sclerosis, taking into account time of day, fatigue, disability level and multiple sclerosis subtype.
DESIGN: Cross-sectional study.
Subjects/patients: Eighty multiple sclerosis patients (Expanded Disability Status Scale, EDSS ≤ 6.5).
METHODS: Participants performed the 6MWT at 3 different time-points (morning, noon, afternoon) during 1 day. Heart rate and pacing strategy (distance covered every minute) were registered. A sub-group analysis determined the effects of fatigue, disability level and multiple sclerosis subtype.
RESULTS: The relative aerobic intensity was constant throughout the day (67 ± 10% of estimated maximal heart rate). In all sub-groups heart rate increased and distance walked declined after the first minute (p < 0.001). The mild EDSS sub-group showed a slightly larger increase throughout the 6MWT in heart rate development, while no differences were seen in sub-groups of fatigue and multiple sclerosis subtype. In most sub-groups walking speed was fastest in the first minute and constant during the final 4 minutes.
CONCLUSION: In patients with multiple sclerosis aerobic intensity is moderate during the 6MWT and unaffected by time of day. Disability may have some influence on aerobic intensity, but not on pacing strategy during the 6MWT, whereas neither fatigue nor multiple sclerosis subtype has any effect.The following 6 data-collecting out-patient centres, being REVAL
Research Institute, BIOMED University of Hasselt and PHL, Belgium
(n=20) and Hospital de Dia de Barcelona, Spain (n=7) and in-patient
centres being Masku Neurological Rehabilitation Center, Masku, Finland
(n=12); The Danish MS Hospital in Ry, Denmark (n=22); Center Neurologique et de Réadaptation Fonctionelle, Fraiture-en-Condroz, Belgium
(n=14); Rehabilitation and MS Center Overpelt, Belgium (n=5) are
acknowledged for their great effort. The RIMS network (www.eurims.org)
is acknowledged for facilitating inter European consultation and testing.
Sources of funding: DG, who coordinated most of the data collection, is
recipient of a PhD Fellowship from the Research Foundation Flanders
(FWO). The FWO is thanked for their Research Grant to PF, the Belgian
Charcot Foundation for Equipment Grants
Arm training in Multiple Sclerosis using Phantom: clinical relevance of robotic outcome measures
No full textAbstract— Upper limb weakness due to Multiple Sclerosis has a major negative effect on the functional activities of the patient. Promising developments in the field of rehabilitation robotics may enable additional exercise. This study aims to investigate which types of robotic outcome measures are clinically relevant, in preparation of the evaluation for intervention studies. Within this context, appropriate movement tasks and tests for the haptic PHANTOM end-effector robot were designed in a virtual environment. These tasks focused on spatial accuracy, object manipulation and speed. Outcome measures were: 1) virtual movement tests, recorded by the robot to quantify motor control; 2) clinical outcome measures such as the Motricity Index, Jamar and MicroFET hand-held dynamometer to evaluate muscle strength; and the Nine Hole Peg Test, Purdue Pegboard, ARAt and TEMPA to asses upper limb function and manual dexterity.10 healthy controls performed the virtual movement tasks using the Phantom as interface. 21 MS subjects with upper limb dysfunction caused by muscle weakness were included in an interventional training study. Pearson correlations were calculated at baseline between the performance on the three virtual movement tasks and the clinical tests on impairment and activity level. The virtual movement tests discriminated between healthy controls and MS patients with hand dysfunction. In the MS patient group, no significant correlations were found between muscle strength tests and virtual movement tasks, while mainly significant correlations were found between specific functional measures (specifically ARAt and Purdue pegboard test) and virtual movement tasks
Arm training in Multiple Sclerosis using Phantom: clinical relevance of robotic outcome measures
No full textAbstract— Upper limb weakness due to Multiple Sclerosis has a major negative effect on the functional activities of the patient. Promising developments in the field of rehabilitation robotics may enable additional exercise. This study aims to investigate which types of robotic outcome measures are clinically relevant, in preparation of the evaluation for intervention studies. Within this context, appropriate movement tasks and tests for the haptic PHANTOM end-effector robot were designed in a virtual environment. These tasks focused on spatial accuracy, object manipulation and speed. Outcome measures were: 1) virtual movement tests, recorded by the robot to quantify motor control; 2) clinical outcome measures such as the Motricity Index, Jamar and MicroFET hand-held dynamometer to evaluate muscle strength; and the Nine Hole Peg Test, Purdue Pegboard, ARAt and TEMPA to asses upper limb function and manual dexterity.10 healthy controls performed the virtual movement tasks using the Phantom as interface. 21 MS subjects with upper limb dysfunction caused by muscle weakness were included in an interventional training study. Pearson correlations were calculated at baseline between the performance on the three virtual movement tasks and the clinical tests on impairment and activity level. The virtual movement tests discriminated between healthy controls and MS patients with hand dysfunction. In the MS patient group, no significant correlations were found between muscle strength tests and virtual movement tasks, while mainly significant correlations were found between specific functional measures (specifically ARAt and Purdue pegboard test) and virtual movement tasks
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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